The Federal Medicaid Managed Care Rule requires Quartz to maintain administrative and management procedures designed to prevent fraud, waste, and abuse. In accordance with these requirements, providers must report and return any overpayments within 60 days of either receiving written notification from Quartz or discovering the overpayment independently. Providers must also submit a written notification to Quartz explaining the reason for the overpayment. All recoveries will be reflected in the encounter data submitted to DHS.
Additionally, all overpayments and underpayments must be reprocessed for up to four years from the date of payment, unless otherwise specified in the Provider Services Agreement.
According to 42 CFR § 438.608(d), Quartz must attempt to recover all overpayments that were made to contracted providers, including those overpayments attributed to fraud, waste, and abuse.
If Quartz discovers the overpayment, we will recover the payment and retain the funds. If DHS identifies the overpayment, Quartz will recover and subsequently retain the funds. Regarding overpayments identified by Quartz, OIG, or DHS, there are no situations wherein Quartz is not permitted to retain the recovered overpayment. This provision does not apply to recoveries retained through federal False Claims Act cases or other such investigations. If you suspect fraud or abuse of the Medicaid program, you may report it at https://www.reportfraud.wisconsin.gov/RptFrd/.
To read more about this, please refer to the Provider Manual.
